Long-term Outcome of a Modified Piggyback Liver Transplantation Technique Using the Recipient's Right and Middle Hepatic Veins
| Autor: | Marília D'Elboux Guimarães Brescia, C E S Baia, Fabricio Ferreira Coelho, A.A. Salzedas-Netto, M.P. Lallee, Daniel Braga Massarollo, Sérgio Mies, Marcio Dias de Almeida, Paulo Celso Bosco Massarollo, Adriana Zuolo Coppini |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Liver transplantation Anastomosis Hepatic Veins Inferior vena cava Left hepatic veins Middle hepatic veins Postoperative Complications medicine Retrospective analysis Humans Retrospective Studies Transplantation business.industry Anastomosis Surgical Patient survival Middle Aged medicine.disease Surgery Liver Transplantation Stenosis medicine.vein cardiovascular system Female business |
| Zdroj: | Transplantation proceedings. 52(5) |
| ISSN: | 1873-2623 |
| Popis: | In early piggyback liver transplantation (LT) descriptions, the common stump of the middle and left hepatic veins (ML) was used for upper caval anastomosis. In this variant, stenosis or kinking of graft venous outflow path was frequent. Over time, most authors adopted the use of the recipient’s right, middle, and left hepatic veins (RML) or a side-to-side anastomosis (SS) between the graft’s and recipient’s inferior vena cava (IVC). Nonetheless, partial IVC clamping required in RML and SS can reduce IVC flow. Since 1998, we incorporated a modified piggyback procedure using the recipient’s right and middle hepatic veins (RM) to simultaneously achieve better preservation of IVC flow and a wide and well-positioned anastomosis. Objective The aim of this study is to describe the RM method and to compare this technique with other standard variants of piggyback LT. Method We conducted a retrospective analysis of 477 piggyback LTs classified in 4 groups: ML (n = 102); RM (n = 171); RML (n = 150); and SS (n = 54). Results The incidence of venous outflow block was 3.9% (4/102) in ML, 2.3% (4/171) in RM, 0% (0/150) in RML, and 3.7% (2/54) in SS (P = .049). On Bonferroni multiple comparison analysis, no statistically significant paired difference was identified. Results showed that 1-, 3-, 5-, and 10-year patient survival was 76%, 67%, 63%, and 51% in the ML group; 80%, 71%, 68%, and 62% in the RM group; 77%, 75%, 70%, and 64% in the RML group; and 76%, 76%, 76%, and 70% in the SS group, respectively (P = .193). Conclusion The RM modified piggyback LT technique is feasible and safe. |
| Databáze: | OpenAIRE |
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